HomeMy WebLinkAboutCLE201400135 Legacy Document 2014-08-13Application f ®r Zoning Clearance
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CLE # `N t 1-4 -
OFFTCE-USE-ONLYY
PLEASE REVIEW ALL 3 SHEETS
Check # a • _
Receipt # Staff:
PARCEL INFORMATION
,
` / Existing Zoning ?p
Tax Map and Parcel: qs- C -2 `'1
Parcel Owner: \ {(LV"\ cky- U n6e V6-) S_Ir� �v�C
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seyl�i City &XIC� l`tt_Swl kState V Zip Zzq O1
Parcel Address: l lq ►\d���1
(include suite or floor)
PRIMARY CONTACT
Who should we call /write concerning this project?
g(nq CCv�n�r��l�„ i I City ��'�yU' �0 0 (e State V Zip 2290 1
Address :J I
Office Phone: )973 -2 Cell # 9a -173Fax # tl ?tl ° 173 7D5 E -mail Vdl hnmo5, C, ckwa l • C om
APPLICANT INFORMATION
Check any that apply: Change of ownership Change of uses_ Change of name New business
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Business Name /Type: g I � i(i I c h. l .kri sfi'an l lY \1A if fl COMM y4V ���
Previous Business on this site
Describe the proposed business including use, number of employees, number of shifts, available parking spaces, number of
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vehicles, and any additional information that you can provide:. S- ,V d 15 1� Lo
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his Clearance will onl9 be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning
Clearance will be required.
I hereby certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the information provided
is true and accurate to the best of my knowledge. I have read the conditions of approval, and I understand them, and that I will abide by them.
Signature Printed
APPROVAL INFORMATION
'[-,e]. Approved as proposed [ ] Approved with conditions [ ] Denied
[ ] Backflow prevention device and /or current test data needed for this site. Contact ACSA, 977 -4511, x117.
[ ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing
site plan.
[ ] This site complies with the site plan as of this date.
Notes:
Building Official Date l �f
Zoning Official / Date
Other Official Date
County of Albemarle iiepartmeni o1 %_.UL1l Ill Ur11Ly UriVVAU x,111 G11L
401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
Revised 7/1/2011 Page 2 of 3
Intake to complete the following:
Islj
Is us m LI, HI or PDIP zoning? If so, give applicant a Certified
Engineer's Report (CER) packet.
Y /I
Wil here be food preparation?
If so, give applicant a Health Department form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on private well or lic ater?
If private well, provide Healt artment form.
Zoning review can not begin until we receive approval from Health
Dept. FAX DATE
Circle the one that applies
Is parcel on septic or pdblic se er?
Y/N
Will you be putting up a new sign of any kind? If so, obtain proper
Sign permit.
Permit #
Y/N
Will there be any new construction or renovations?
If so, obtain the proper Permit.
Permit #
7--" 4n nmm1n1nfn Ap fnllnwina.
Reviewer to complete the following:
Square footage of Use:
Permitted as: -74i D'/ / & al
Under Section: / e a„ j2,^a r `e..
Supplementary regulations section:
Parking formula:
Required spaces:
Y/
Item be verified in the field:
Inspector:
Notes:
Date:
Violations: V _
If so "I ist:
Proffers:
Y /
If s ist:
Var► ce:
If so,
SP's:
Y
If OList:
Clearances:
SDP's
Revised 7/1/2011 Page 3 of 3
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